A systematic review of attachment and psychosis: measurement, construct validity and outcomes

Gumley, Andrew; Taylor, Henry Osborn; Schwannauer, Matthias; MacBeth, Angus

doi:10.1111/acps.12172

Cited by 190 publications

(220 citation statements)

References 56 publications

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“…Exposure to childhood trauma is common among UHR individuals (Kraan et al, 2015a), although evidence linking it to increased risk of transition to psychotic disorder in this group remains inconclusive (Thompson et al, 2014;Kraan et al, 2015b;Stowkowy et al, 2016). Poor engagement with clinical services, more severe psychiatric symptoms and cognitive impairment have all been linked to childhood trauma in patients with psychosis (Aas et al, 2014;Gumley et al, 2014). Post-traumatic stress disorder (PTSD) may also be a comorbid problem among those individuals exposed to trauma, which in turn is associated with poorer employment outcomes even among individuals with serious mental illness (Mueser et al, 2004a;2004b).…”

Section: Discussionmentioning

confidence: 99%

Long-term employment among people at ultra-high risk for psychosis

Cotter

Lin

Drake

et al. 2017

Schizophrenia Research

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Word count abstract: 250Word count paper: 2,894 Number of tables: 2Supplementary data: Supplementary Table 1 2 Abstract BackgroundPsychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultrahigh risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort. Method UHR patients recruited from the Personal Assessment and Crisis Evaluationclinic in Melbourne, Australia were followed-up over 2-14 years after initial presentation to the service. Individuals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome. ResultsA high rate of unemployment was present at follow-up in this UHR sample (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed individuals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses.3 ConclusionsNearly a quarter of this UHR sample were unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.

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Section: Discussionmentioning

confidence: 99%

Long-term employment among people at ultra-high risk for psychosis

Cotter

Lin

Drake

et al. 2017

Schizophrenia Research

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“…There is also evidence that childhood trauma is associated with higher rates of insecure attachment in adulthood among patients with psychosis (Tait et al 2004;Berry et al 2009). Compared with patients with secure attachments, insecure attachment has been associated with worse psychiatric symptoms (Gumley et al 2014) and social cognitive performance (Pos et al 2014). It has also been associated with poorer engagement with clinical services and more interpersonal problems (Gumley et al 2014), including poorer treatment adherence and greater likelihood of disengagement from mental health services (Tait et al 2004;MacBeth et al 2011).…”

Section: Attachmentmentioning

confidence: 99%

“…Compared with patients with secure attachments, insecure attachment has been associated with worse psychiatric symptoms (Gumley et al 2014) and social cognitive performance (Pos et al 2014). It has also been associated with poorer engagement with clinical services and more interpersonal problems (Gumley et al 2014), including poorer treatment adherence and greater likelihood of disengagement from mental health services (Tait et al 2004;MacBeth et al 2011). These may all be important factors that contribute to the association between childhood trauma and poor functioning in these patient groups.…”

Section: Attachmentmentioning

confidence: 99%

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Cotter

Kaess

Yung

2014

Ir. j. psychol. Med.

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Objectives. We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.Methods. Narrative review of the peer-reviewed English language literature in the area.Results. High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment. Conclusions.Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

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“…A large and influential epidemiological study found evidence for an association between insecure adult attachment and schizophrenia (Mickelson et al, 1997), and although this association has been replicated in non-clinical (Berry et al, 2007b;Berry et al, 2006;Korver-Nieberg et al, 2014;Meins et al, 2008) and clinical samples (Berry et al, 2007a;Gumley et al, 2014;Korver-Nieberg et al, 2014;Korver-Nieberg et al, 2015;Ponizovsky et al, 2007;Ponizovsky et al, 2013) it has been suggested that it could be more informative to explore such associations in relation to specific symptoms of psychosis (Bentall, 2004). Such specificities can provide a clearer understanding of how certain psychological mechanism are meaningfully related to the experiences of individuals with psychosis (Bentall and Fernyhough, 2008) and, in turn this information may help clinicians focus psychological interventions appropriately.…”

Section: Introductionmentioning

confidence: 99%

The dynamics of attachment insecurity and paranoid thoughts: An experience sampling study

Sitko

Varese

Sellwood

et al. 2016

Psychiatry Research

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It has been proposed that insecure attachment can have adverse effects on the course of psychosis once symptoms have emerged. There is longitudinal evidence that increased insecure attachment is associated with increased severity of psychotic symptoms. The present study examined whether in the flow of daily life attachment insecurity fluctuates, whether elevated stress precedes the occurrence of attachment insecurity, and whether elevated attachment insecurity precedes the occurrence of paranoia. Twenty clinical participants with a psychosis-spectrum diagnosis and twenty controls were studied over six consecutive days using the experience sampling method (ESM). The findings revealed that fluctuations in attachment insecurity were significantly higher in the clinical group, that elevated stress predicted a subsequent increase in attachment insecurity, and that elevated attachment insecurity predicted a subsequent increase in paranoia; this effect was not observed in auditory hallucinations once co-occurring symptoms were controlled for. Finally, although previous ESM studies have shown that low self-esteem precedes the occurrence of paranoia, attachment insecurity continued to predict paranoia even when self-esteem was controlled for. The findings suggest that attachment security may be associated with a lower risk of paranoia, and that psychological interventions should address attachment beliefs and work towards establishing a sense of attachment security.

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A systematic review of attachment and psychosis: measurement, construct validity and outcomes

Cited by 190 publications

References 56 publications

Long-term employment among people at ultra-high risk for psychosis

Long-term employment among people at ultra-high risk for psychosis

Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

The dynamics of attachment insecurity and paranoid thoughts: An experience sampling study

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